Leading by Doing: Dr. Joycelyn Elders on Creating Change

FRIDAY, MARCH 18, 2011 :: By Anjetta McQueen

M. Joycelyn Elders, MD, former U.S. Surgeon General

M. Joycelyn Elders, MD, the Surgeon General of the United States Public Health Service in the Clinton administration, will address the 2011 Union Delegates Conference about transformational leadership and health care reform. In an interview with LMP Communications, the trail-blazing physician and public health advocate addressed leadership and change.

A call to leadership: opportunity and obligation

Dr. Elders believes that Kaiser Permanente, through the work of its teams, has the opportunity—and the obligation—to spread a model of patient-focused care and the promise of true health care reform.

In the United States, she noted, “we have the best doctors, nurses and hospitals in the world. Yet we do not have a system to adequately deliver care.”

“Cost is the greatest fear right now, but the most expensive thing we can do is what we are doing now,” she said. “Instead, we should be getting people involved in their own health care. We can’t afford what we are doing now.”

A pediatrician, Dr. Elders recalls that by the time she had her first baby, she had written hundreds of orders for new moms but knew little about how they were carried out.

“When it came time to feed the baby, the nurses had to educate me,” she said. That realization led to a deeper appreciation of what each individual contributes to the whole. “We are all leaders, in our way. Nurses know more about nursing that anyone else in the system.”

And Kaiser Permanente, she believes, has a great deal to contribute to U.S. health care.

“The good thing about KP is that you are far ahead of anybody else. Individual doctors cannot do what you can,” she said. “We need to develop a system that we can take across the entire country, and you are the ones to do it….If you don’t do it, who will?”

Leadership qualities: confront change with responsibility

For Dr. Elders, there is a simple recipe for a leader who seeks to bring change—whether to a single unit, a hospital, a state or a nation: “You may not have been born a leader, but you are able to learn. You have to work hard for it, believe in what you are doing, and have the honesty and integrity to carry it out.”

And a transformational leader, she said, “is simply a leader who is willing to lead and takes responsibility for that leadership role. Nobody ever wants to step off that cliff and lead the transformation. But a good leader can lead in any situation as long as you have honesty, integrity and vision.”

She was chief pediatric resident of a Little Rock hospital in the early 1960s, when many racial and gender barriers remained in Arkansas, but it didn’t take long before the nine white male doctors on her staff were calling her “chief.” And they do so to this day. She credits her honesty and fairness in their acceptance of her as a unit leader.

“I knew that I needed to be informed. I needed to be there. I could not be one of those leaders who sat in an office and looked out the window waiting for someone to come in and bring me stuff and tell me what was going on….I had to get out and see and do for myself, right along side everyone else. And if I goofed up, I didn’t mind admitting it.”

And if people are unwilling to shift? Her advice: “Whenever you are looking at resistance to change, you have to make sure you put everything on the table.”

Growing into leadership: meeting a mission head-on

In the 1980s, Dr. Elders assumed the helm of the Arkansas Department of Health with a mission: curbing the state’s rampant teenage pregnancy rates, which were among the highest in the industrialized world. Taking on controversial issues of sexuality and poverty, she honed leadership skills that would prepare for her challenging role as Surgeon General a decade later.

“I went from being a professor at a university,” she said, “to trying to change a health department and an entire state.”

She became well versed on what happened to children of unwed teenagers. They are more likely to be in prison, more likely to live in poverty, least likely to get higher education.

Many of the teens were not married. Many of them were African-American, like her. That gave her an opportunity, she says: “I saw myself in a special role. I could say things a man could not say; I could say things that a white person could not say.”

Dr. Elders persuaded schools to offer a comprehensive program for teens, from abstinence to birth control. Crisscrossing the state, she became part advocate, part missionary, all scientist, lecturing and mentoring teens in her public appearances. Women and men have approached her years later, her words of admonishment and encouragement echoing in their teen memories.

Dr. Elders explains how she engaged in “personal leadership,” confronting a major societal problem virtually one teen at a time.

“Let me tell you, there was opposition to what I was doing and some of it was very vocal. But you can’t worry about that.

“I would tell the girls who I saw, ‘I want you to be educated, motivated and full of hope for the future, and you can’t do that if you are having a baby every year.’ As for the boys, I would tell them, ‘there’s more to being a father than donating sperm.’ ”

During her tenure, teen pregnancy rates in Arkansas did fall, a fact highlighted by then-Gov. Bill Clinton in his bid for the White House.

She was confirmed as the 16th Surgeon General in 1993, serving in that office for 15 months. She drew on the strength from her rural, segregated, poverty-stricken childhood, bringing up controversial topics for discussion despite political opposition.

She returned to teaching after leaving office and has remained active in public health education. She is now a professor emeritus at the University of Arkansas School of Medicine.